Coffee and herbal tea consumption is associated with lower liver stiffness in the general population: The Rotterdam study

      Background & Aims

      Coffee and tea have been proposed to limit the progression of liver fibrosis in established liver disease, but it is unknown if this is also true for subclinical fibrosis. We therefore aimed to evaluate whether coffee and tea consumption are associated with liver stiffness in the general population.


      The Rotterdam Study is an ongoing prospective population-based cohort. We included participants who underwent transient elastography, ultrasound and completed a food frequency questionnaire. Coffee and tea consumption were categorized into no, moderate (>0–3), or frequent (⩾3) intake (cups/day), and tea further into green, black and herbal tea (no/any). Significant fibrosis was defined as liver stiffness measurements (LSM) ⩾8.0 kPa. We performed regression analyses relating coffee and tea intake with fibrosis, steatosis and log-transformed LSM and adjusted for energy, sugar and creamer intake, age, gender, BMI, steatosis/LSM, HOMA-IR, ALT, alcohol, smoking, soda, healthy diet index and physical activity.


      We included 2,424 participants (age 66.5 ± 7.4; 43% male) of whom 5.2% had LSM ⩾8.0 kPa and 34.6% steatosis. Proportion of LSM ⩾8.0 kPa decreased with higher coffee consumption (7.8%, 6.9% and 4.1% for no, moderate and frequent respectively; Ptrend = 0.006). This inverse association was confirmed in multivariable regression (ORmod 0.75, 95% CI 0.33–1.67; ORfreq 0.39, 95% CI 0.18–0.86; p = 0.005). Amongst tea consumers, only herbal tea consumers (36.3%) had lower log-transformed LSM after adjustment (Beta-0.05, 95% CI-0.08;-0.02, p = 0.001). Subtypes of tea were associated with steatosis in univariate but not multivariable analysis.


      In the general population, frequent coffee and herbal tea consumption were inversely related with liver stiffness but not steatosis. Longitudinal analyses, as well as studies validating and unravelling underlying mechanisms are needed.

      Lay summary

      The Rotterdam Study is a large ongoing population study of suburban inhabitants of Rotterdam in whom data on liver stiffness, as proxy for liver fibrosis, presence of fatty liver on ultrasound and detailed information on coffee and tea consumption were obtained in 2,424 participants. The consumption of herbal tea and daily consumption of three or more cups of coffee was related to the presence of lower liver stiffness, independent of a great number of other lifestyle and environmental factors. Previous studies have found a protective effect of coffee on established liver disease and we now show for the first time that this effect is already measurable in the general population.

      Graphical abstract


      Linked Article

      • Association between beverage consumption and liver fibrosis
        Journal of HepatologyVol. 68Issue 5
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          We read with interest the study by Alferink et al.1, which is a questionnaire investigation among 2,424 participants in the general population, of whom 5.2% had significant liver fibrosis (SLF) defined as liver stiffness measurements ≥8.0 kPa. It concluded that the consumption of herbal tea, but not black or green tea, was related to the presence of lower liver stiffness, as was frequent coffee consumption (≥3 cups/day), but not no or moderate coffee consumption (<3 cups/day). Herein, we would like to raise the following issues:
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      • Herbal tea and liver injury – Tea extract or comedication can make a difference
        Journal of HepatologyVol. 69Issue 2
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          With great interest we read the study by Alferink et al.1 and the following letter by Philips and Augustine.2 They raise the valid concern that green tea has been reported to cause severe liver injury ( ).
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      • Herbal tea consumption and the liver – All is not what it seems!
        Journal of HepatologyVol. 68Issue 3
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          We read with interest the study by Alferink et al. on the relationship between coffee and herbal tea consumption and liver stiffness in the general population. We congratulate the authors on publishing the largest ever study reporting on the relationship between coffee, tea and liver health in a general population and the only one also reporting on tea intake and liver health. This study was a cross sectional analysis of The Rotterdam Study, a large ongoing population-based cohort of participants in a Dutch suburb.
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      • Reply to: “Herbal tea consumption and the liver – All is not what is seems!”
        Journal of HepatologyVol. 68Issue 3
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          We would like to thank Drs Philips and Augustine for their valuable comments on our study on coffee and tea consumption in relation to liver health in the general population.1,2 In our study we show that both coffee as well as herbal tea are associated with lower liver stiffness independent of many potential confounding factors. In their letter, Philips and Augustine raise the valid concern that papers like ours may convey a general message that consumption of tea containing herbal extracts or other complex mixtures is evidently beneficial and safe.
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      • Reply to: “Association between beverage consumption and liver fibrosis”
        Journal of HepatologyVol. 68Issue 5
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          Thank you for the opportunity to reply to the letter by Huang et al.1 The authors of this letter posed two main questions, which we will address consecutively. First, they questioned why we categorised subtypes of tea (no vs. any) differently from coffee consumption (no, moderate, and frequent). This is simply related to the small number of participants with frequent tea consumption, 91 participants reported frequent green tea consumption and 162 reported frequent herbal tea consumption, which would hamper the ability to perform robust multivariable analyses within subcategories.
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      • The impact of coffee consumption on fibrosis and steatosis in HIV-HCV co-infected patients
        Journal of HepatologyVol. 68Issue 4
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          Alferink et al.1 report novel results regarding the protective effects of coffee and herbal tea consumption on liver stiffness, which is a proxy for liver fibrosis, measured using FibroScan. Their cross-sectional study was nested inside a large population-based cohort of participants aged 45 and older (mean age 66.5 ± 7.4 years) in Rotterdam.
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